Support

A cookie is a piece of data stored by your browser or device that helps websites like this one recognize return visitors. We use cookies to give you the best experience on BNA.com. Some cookies are also necessary for the technical operation of our website. If you continue browsing, you agree to this site’s use of cookies.

Republican Proposals Would Reduce Health-Care Coverage, RAND Finds

Nov. 18 — Health-care proposals being considered by Republicans would likely result in lower
coverage than the Affordable Care Act, a RAND Corp. researcher said Nov. 18 at a
Capitol Hill
symposium.

However, RAND senior economist Christine Eibner said, “There’s a lot of variability
across the different proposals, which suggests to me that there is an opportunity
by tweaking some of the parameters to get back to that level”
achieved under the ACA.

Republicans are moving full steam ahead with plans to repeal and replace the Affordable
Care Act, as President-elect Donald Trump and congressional Republicans have pledged
to do. However, they face the challenge of keeping coverage for the 20 million people
who have gained it under the law while not raising the federal deficit. Under the
analysis Eibner presented, with provisions of the ACA in place, 252 million people
have coverage, while repealing the law and replacing the Medicaid expansion with a
block grant to states, as Trump and Republicans have called for, would leave 227 million
with coverage.

Medicaid Block Grants Result in Lowest Coverage

According to RAND’s analysis, repealing the ACA’s Medicaid expansion provision and
replacing it with a block grant to states would result in the lowest level of health-care
coverage, while repealing the law and allowing health insurance sales across state
lines would leave 234 million people with coverage and repealing the ACA and enacting
the
Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act offered by Sens. Richard Burr
(R–N.C.) and Orrin Hatch (R–Utah) and Rep. Fred Upton
(R–Mich.) would result in 243 million having health-care coverage. RAND is a nonprofit
organization that conducts public policy research.

Although the Republican plans, which include the
Better Way plan put forward by House Speaker Paul Ryan (R-Wis.), would reduce federal spending, in
most cases they result in a higher federal deficit because they reduce revenue from
taxes included in the ACA, Eibner said.

“Subsidies are important to expanding coverage through tax credits,” and they are
more important to getting people covered than the ACA’s individual mandate, Eibner
said.

Ryan’s Better Way plan would provide tax credits to help people without access to
job-based or public coverage buy health insurance, while the Burr-Hatch-Upton proposal
would allow subsidies for people with income as high as 300 percent of the federal
poverty level.

Under the ACA, tax credit subsidies are available for people with income between 100
percent to 400 percent of the poverty level.

ACA Medicaid Expansion Accounts for Largest Share of Gains

The ACA’s Medicaid expansion accounts for a large share of the law’s coverage gains,
Eibner said. Block grants of lump sum payments to states would cap federal expenditures
for the health-care program for the poor, but they run the risk of reducing coverage
or making coverage less generous, she said.

RAND also analyzed some “more out-of-the-box ideas as ways of trying expand coverage
in the U.S.,”
Eibner said.

Eliminating the exclusion from taxes for employer-provided insurance and using the
revenue to provide subsidies to low-income people could increase coverage by 4 million
people relative to current law as well as a reduction in the federal deficit, she
said.

The Congressional Budget Office has estimated the tax exclusion carries an implicit
loss of
$260 billion in lost revenue, she said.

Providing all Americans with high-deductible insurance plans, funded with a per-capita
tax, would result in 16 million more people covered and a reduction in the deficit,
Eibner said.

To contact the reporter on this story: Sara Hansard in Washington at
shansard@bna.com

To contact the editor responsible for this story: Kendra Casey Plank at
KCasey@bna.com

All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to books@bna.com.

Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)

Notify me when updates are available (No standing order will be created).

This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to research@bna.com.

Put me on standing order

Notify me when new releases are available (no standing order will be created)